Usefulness of C-reactive protein in monitoring the severe community-acquired pneumonia clinical course

Abstract

Background: The aim of the present study was to evaluate the C-reactive protein level, the body temperature and the white cell count in patients after prescription of antibiotics in order to describe the clinical resolution of severe community-acquired pneumonia.

Methods: A cohort of 53 consecutive patients with severe community-acquired pneumonia was studied. The C-reactive protein levels, body temperature and white cell count were monitored daily.

Results: By day 3 a C-reactive protein level 0.5 times the initial level was a marker of poor outcome (sensitivity, 0.91; specificity, 0.59). Patients were divided according to their C-reactive protein patterns of response to antibiotics, into fast response, slow response, nonresponse, and biphasic response. About 96% of patients with a C-reactive protein pattern of fast response and 74% of patients with a slow response pattern survived, whereas those patients with the patterns of nonresponse and of biphasic response had a mortality rate of 100% and 33%, respectively (P < 0.001). On day 3 of antibiotic therapy, a decrease in C-reactive protein levels by 0.31 or more from the previous day's level was a marker of good prognosis (sensitivity, 0.75; specificity, 0.85).

Conclusion: Daily C-reactive protein measurement after antibiotic prescription is useful in identification, as early as day 3, of severe community-acquired pneumonia patients with poor outcome. The identification of the C-reactive protein pattern of response to antibiotic therapy was useful in the recognition of the individual clinical course, either improving or worsening, as well as the rate of improvement, in patients with severe community-acquired pneumonia.

Figure 1

C-reactive protein levels. C-reactive protein (CRP) levels on the day of antibiotic prescription (▲, day 0) and on the last day of antibiotic therapy in survivors or at death in nonsurvivors (■). Data presented as the mean ± standard deviation. ^#P = 0.591. ^¶P = 0.021. *P < 0.001.

Figure 2

Time-dependent analysis of the C-reactive protein ratio during antibiotic therapy. Time-dependent analysis of the C-reactive protein (CRP) ratio during antibiotic therapy, from day 0 to day 7 of antibiotic therapy, was significantly different between survivors (▲) and nonsurvivors (■). P = 0.039.

Figure 3

Maximal daily C-reactive protein variation. Receiver-operating characteristics curve of the maximal daily C-reactive protein variation from the level of the previous day. Area under the curve, 0.76 (95% confidence interval = 0.61–0.86).